The underlying causes of tardive syndrome (TS) are not entirely understood, but hypotheses suggest dopaminergic receptor hypersensitivity and oxidative stress as potential contributors. Diagnosis typically requires symptoms to persist for at least a month after discontinuing the drug, and it can be challenging to differentiate from other similar conditions.

The treatment of TS involves a multifaceted approach. First, determining the offending drug and considering whether discontinuation or replacement with atypical antipsychotics like quetiapine or clozapine is possible. Vesicular monoamine transporter-2 inhibitors such as tetrabenazine, deutetrabenazine, and valbenazine are commonly used to manage symptoms by reducing dopamine availability in the synapse. These agents are often more effective with fewer side effects than older treatments like tetrabenazine. In refractory cases, other treatments, including benzodiazepines like clonazepam, amantadine for parkinsonism, and botulinum toxin for dystonia, can be considered. For severe cases, deep brain stimulation of the globus pallidus interna has shown promise in improving symptoms, particularly in patients who do not respond to medical treatments. Further research is needed to refine treatment strategies and understand the complex mechanisms of TS.

Reference: Badarny S, Nassar R, Badarny Y. Tardive Syndrome Is a Mysterious Phenomenon with Different Clinical Manifestations-Review. J Clin Med. 2023;12(4):1498. doi: 10.3390/jcm12041498.